The American journal of emergency medicine
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As emergency medicine comes of age, it is interesting to examine the scientific nature of the specialty as reflected in the literature. Representative volumes of three emergency medicine journals were reviewed for number and type of article, institutional origin, article length, and number of authors. For Annals of Emergency Medicine, (AEM) volumes for 1975, 1980, and 1985 were studied. ⋯ However, there are increasing numbers of papers with multiple authors. Listing of multiple authors on papers has prompted criticism of the literature in other medical specialties. If this trend continues, there may be a risk of compromising the integrity of the published research.
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All cases of patients aged less than 48 months who presented in cardiac arrest to the Hennepin County Medical Center's emergency department (ED) during the years 1984 to 1986 were reviewed retrospectively. The ED record, initial and subsequent chest radiographs, hospital charts, and autopsy reports were analyzed. A total of 33 cases were reviewed. ⋯ Percutaneous peripheral catheterization, when successful, and bone marrow needle placement were the fastest methods of obtaining intravascular access. There were no major immediate complications, and delayed complications were minimal. Attempts at peripheral intravenous catheter placement should be brief, with rapid progression to intraosseous infusion if peripheral attempts are not successful.
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A 3-year-old child presented to the emergency department (ED) with the sudden onset of shortness of breath and wheezing. The child had previously been in good health and had no problems during the neonatal period. ⋯ The diagnosis was confirmed, and recovery was uneventful. The differential diagnosis of late onset congenital diaphragmatic hernia is discussed with an emphasis on both early recognition and differential diagnosis of this rare but correctable entity.
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The clinical management of 12 patients with major intrathoracic tracheobronchial rupture (complete, 3; incomplete, 9) due to blunt trauma has been reviewed and compared with that of two groups of patients with chest injuries not involving the tracheobronchial tree, 17 patients with multiple rib fractures and 17 with chest injuries requiring thoracotomy for control of pneumothorax and hemothorax. The effect of injury on ventilatory function was significantly greater in the patients with tracheobronchial injury in whom an elevated PCO2 at the time of admission was associated with a poor prognosis. Conventional ventilatory management with endotracheal intubation and positive pressure ventilation causing increased air leakage produced further deterioration of pulmonary function in four of the patients with tracheobronchial disruption. The use of a double-lumen endobronchial tube in two patients with tracheobronchial rupture facilitated ventilatory support and subsequent operative management.
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Prehospital patient management decisions are complex because the traumatized patient population is heterogeneous with respect to demographics, mechanism of injury, physiological response to injury, and time from injury to medical care. One hundred and nine blunt trauma patient evaluations by paramedics in a county-wide semirural emergency medical services (EMS) system were analyzed to determine paramedic time on the scene and the factors that might influence onscene time. Onscene time linearly correlated with a prolonged transport time. ⋯ However, patient groups with either a low TS or a low GCS score showed no significant improvement in TS with increasing onscene time. Without a strict management algorithm, paramedics use a variety of cues to guide their actions during the onscene management of blunt trauma. Future studies should address the impact of strict management algorithms on onscene time and ultimate patient outcome.